30 December 2008

One of the good things about being older is that you can remember how things used to be. There is the strong risk of the rose-tinted retrospectoscope and you can't go back to check on your memory or show youngsters how it used to be but you can be pretty sure of some things.

Dr Grumble did a ward round on Christmas Eve. He doesn't usually do a ward round on a Wednesday but his junior staff wanted him to. The timing of the round was their idea. They were worried about the long weekend. So was Dr Grumble. He never likes these long holiday periods for patient care. The worry of the managers was very different. The Grumble hospital has been very full. The possibility of running out of beds over Christmas was frightening them. But it never seems to happen that way. For all sorts of reasons the pressure is off at Christmas time. Nevertheless Grumble thought it was his duty to try and get patients home for Christmas. You might think patients would like that. But you would be wrong. For the lonely Christmas is the loneliest time. The second patient Dr Grumble saw did not want to go home for Christmas nor the third. And so it went on.

Dr Grumble can remember what the consultants of old would have done. They would have been compassionate. They would have invited these lonely people to stay for Christmas Day and we would have had a great big turkey. A real turkey. And Dr G's consultant would have come in on Christmas Day and carved it. We would have had a nice party and presents would be flying in all directions.

But those days are long gone. Dr Grumble had to ask his staff why these patients were still in hospital. The was no reason. Not a real reason. It was just that nobody had had the heart to send them home. Except, that is, Dr Grumble. He wishes it could be otherwise. But you can't turn the clock back. And we must have the beds.

Posted by
Dr Grumble

5 comments:

If you are a manager you should read this pdf from the NHS Confederation. If you are a politician you are probably only interested in what the press think so this is for you. And if you don't believe the NHS Confederation has it right then read this which shows that the King's Fund is also onto this problem. And for the managers there is this from the King's Fund.

Well even the hospices were looking empty over Christmas, one of the main dynamics being that for many lucky people they have enough extended family off over the holidays to look after them over their (probably last) Christmas, and the hospice staff are ever so good at giving support so that this can be done, and beds are immediately available if they need to be taken back for some reasonInterestingly heard the views of the palliative care consultants, docs and nurses up close and personal as it were, and they are even more disgusted than I am about the state of the local NHS hospitals"they make me ashamed to be a nurse""they make me ashamed to be a doctor"etc etcAlso the hospices supported the Christmas short releases to home in ways which the NHS hospitals could really learn from, such as good drugs lists for the family, with when/why how to administer etcMeanwhile the local NHS hospitals kick some of the most vulnerable people in the country out Friday evenings just before the pubs shut (and the drunken fights start - needing hospital beds) without any consultant having made that decision, with no word to the GP, with nothing but 2 days of drugs to get the patient over the weekend and forcing the patient to queue as an emergency at their GP on the Monday morning when their morphine has run outI really really really don't see how some of our hospitals are allowed to continue, they wouldn't survive in a free market economy where the patients had any choice whatsoever, and they wouldn't survive in a communist model either many of their leaders would have been took out and shot, yet in this no mans land of nhs fantasy they survive while being national disgracesI wouldn't work in these nhs places, id resign, my heart wouldn't allow me to see such crap patient careWhy does Dr Grumble still do it?All of the disgusted consultants resigning would being some honesty to the table, and force some change, change which the patients should be able to force but which they currently have no power to nudgehttp://notdrrant.blogspot.com/

Dr Grumble's registrar has recently found a senior position in North America and two of Dr Grumble's colleagues now work for the local football club. One is a radiologist, the other was a GP. Apparently the football club pays more and the work is easy. But the NHS is worse off as a result.

I suspect we are seeing a kind of dehumanisation of the NHS and most public sectors.

Are bed managers as crazy as they used to be or have they calmed down now :) - ie now that there are no beds. I recall having to find a bed for a patient who was at a police station. I tried to explain what a " acute psychotic episode" was to a manager at 3am in the morning. He told me to discharge the patient because he didn't understand what the ward " psychotic meant". Two hours later, I was onto the next manager in the pecking order, who then had to call a consultant to translate the issues ie the word " psychotic" and the word " acutely suicidal".

It took me 8 hours, on my mobile phone to get the funding of a bed agreed in London - 80 miles away from the patient's home. By then, I had been at said police station waiting for these managers to translate some basic medical terms to justify an ECR bed.

I got the patient a bed, transfer occurred 16 hours later. Had beds been at their usual, it would have taken 1-2 hours maximum.

You wouldn't have to fuss with all that now - there are scarcely any beds left thanks to PFI. All part of the privatisation that No one is so fond of.

Of course, there are the respite beds, but that has a knock on effect so that people that need to be in those are on home treatment instead and people that need to be on home treatment are getting the occasional visit from a CPN and so on.

Just wait until they privatise the rest of it.

Last time I started sleeping rough when psychotic, there was a bed for me. There wouldn't be one now. At this rate, it will be like the US with people like me ending up on the streets or in prison. That won't be cheaper, but it will come out of a different budget.